Opioid Prescribing in Medicaid: Healthcare Utilization and Deaths from Overdose

医疗补助中的阿片类药物处方：医疗保健利用和过量死亡

• 批准号: 9229541
• 负责人: Jayani Jayawardhana
• 金额: $ 22.5万
• 依托单位: UNIVERSITY OF GEORGIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9229541
• 关键词: Acute Pain; Address; Awareness; Behavior; Benzodiazepines; Caring; Cessation of life; Community Health; Control Groups; Criminal Justice; Data; Death Rate; Dose; Drug Prescriptions; Effectiveness; Enrollment; Formularies; Health; Health Care Costs; Health Personnel; Health Professional; Individual; International Aspects; Lead; Least-Squares Analysis; Measures; Medicaid; Medical; Medical Assistance; Medical Care Costs; Modeling; Natural experiment; North Carolina; Opioid; Opioid Analgesics; Outcome; Overdose; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Policies; Policy Maker; Population; Population Group; Public Health; Public Health Schools; Research; Risk; Substance Use Disorder; Techniques; Testing; Time; United States; United States Centers for Medicare and Medicaid Services; Universities; Vulnerable Populations; Woman; Work; college; cost; demographics; design; drug misuse; expectation; health care service utilization; health service use; improved; innovation; men; misuse of prescription only drugs; opioid misuse; opioid use; overdose death; prescription drug abuse; prescription opioid; prescription opioid abuse; programs; public health relevance; service utilization; socioeconomics; statistics

 DESCRIPTION (provided by applicant): The misuse and potential inappropriate prescribing of prescription opioid analgesics is a growing public health concern in the U.S. The dramatic increase in prescription opioid use has led to disconcerting effects including misuse, abuse, and negative health consequences such as death from overdose and increased utilization of healthcare services. Even with heightened awareness of this issue, the majority of states have not developed strategies to help curb prescription drug abuse. Inappropriate prescribing of opioids is a key factor related to the misuse of these medications and related negative health outcomes. Prescribing high doses of opioids, concomitant opioid-opioid/opioid-benzodiazepine/opioid- Suboxone use, prescribing opioids for long durations, and prescribing long acting/extended release opioids for acute pain or for opioid naive patients are indicators of inappropriate prescribing. By creating formulary policies to limit access to opioid analgesic prescriptions under these conditions, policy makers and formulary managers have the potential to reduce the misuse and inappropriate prescribing of opioids, unnecessary healthcare utilization and overdose deaths. The proposed study uses Georgia and North Carolina Medicaid pharmacy and medical claims data from 2009 to 2014 to evaluate the impact of Georgia Medicaid formulary policy changes on three outcomes: 1) potential misuse and inappropriate prescribing of opioid analgesic medications; 2) utilization of healthcare services; and 3) deaths due to overdose. This study will directly measure the impact of formulary policy changes implemented by Georgia Medicaid in 2012/2013 designed to limit abuse, misuse, diversion and inappropriate prescribing, health services utilization and deaths from overdose. These policies include a limit on the number of prescriptions allowed per recipient per month, a change in the refill-too-soon rate from 75% of days' supply used to 85% of days supply used, and blocking concomitant use of any opioid and Suboxone. Study hypotheses are tested using descriptive statistics and panel data econometric analyses techniques. This innovative research is among the first studies to examine the impact of formulary policy changes on these three important contributors to the opioid crisis. Results of the study will provide evidence regarding the effectiveness of policy-level strategies to reduce misuse and inappropriate prescribing of opioids which is expected to lead to improved patient outcomes, decreased utilization of healthcare services and reduced costs of medical care. Results will inform key decision makers, allowing them to choose approaches that are most likely to reduce misuse of prescription drugs and drug overdose in states as well as to help states identify strategies that are effective in addressing a national crisis related to the abuse of prescription opioid analgesics.

 描述（由申请人提供）：处方阿片类镇痛药的滥用和潜在的不当处方是美国日益关注的公共卫生问题。处方阿片类药物使用的急剧增加导致了令人不安的影响，包括误用、滥用和负面健康后果，例如因用药过量而死亡和医疗服务利用率增加。尽管人们对这一问题的认识有所提高，但大多数州尚未制定有助于遏制处方药滥用的战略。阿片类药物处方不当是导致滥用这些药物和相关负面健康结果的一个关键因素。开出高剂量阿片类药物、同时使用阿片类药物-阿片类药物/阿片类药物-苯二氮卓类/阿片类药物-赛博松、长期开出阿片类药物处方、以及为急性疼痛或未使用阿片类药物的患者开出长效/缓释阿片类药物，这些都是不适当处方的指标。通过制定处方政策来限制在这些情况下获得阿片类镇痛处方，政策制定者和处方管理人员有可能减少阿片类药物的滥用和不当处方、不必要的医疗保健使用和过量死亡。拟议的研究使用 2009 年至 2014 年佐治亚州和北卡罗来纳州医疗补助药房和医疗索赔数据来评估佐治亚州医疗补助处方政策变化对三种结果的影响：1）阿片类镇痛药物的潜在滥用和不适当处方； 2）医疗保健服务的利用； 3) 因服药过量而死亡。本研究将直接衡量乔治亚州医疗补助计划在 2012/2013 年实施的处方政策变化的影响，这些政策变化旨在限制滥用、误用、转移和不当处方、卫生服务利用和用药过量造成的死亡。这些政策包括限制每个接受者每月允许的处方数量、将过早补充率从使用天数的 75% 更改为使用天数的 85%，以及禁止同时使用任何阿片类药物和 Suboxone。使用描述性统计和面板数据计量经济学分析技术来检验研究假设。这项创新研究是首批研究处方政策变化对阿片类药物危机的这三个重要因素的影响的研究之一。该研究的结果将提供有关政策层面策略有效性的证据，以减少阿片类药物的滥用和不当处方，预计将改善患者的治疗结果，减少医疗服务的利用率并降低医疗成本。结果将为关键决策者提供信息，使他们能够选择最有可能减少各州滥用处方药和药物过量的方法，并帮助各州确定有效解决问题的策略。 与滥用处方阿片类镇痛药有关的国家危机。